Stephanie Tickerhoff, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

201811 Issued in NC

Practice address

280 Broad St
Suite a
Kernersville, NC 27284-2796

Phone

(336) 277-6430

Fax

(336) 277-6448

NPI assigned

Feb 28, 2008

Last updated

Oct 28, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Moses Cone Physician Services, IncGroup PAC ID 4284782210, 397 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Moses Cone Physician Services, Inc.

  • Internal Medicine Physician
  • Greensboro, NC
  • NPI 1093953127

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment NPD
• Moses Cone Physician Services Inc

  dba Triad Hospitalists

  • Hospitalist Physician
  • Greensboro, NC
  • NPI 1326363383
  NPD
• Moses Cone Physician Services, Inc.

  dba CHMG Medical Weight Management Center

  • Family Medicine Physician
  • Greensboro, NC
  • NPI 1174049027
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Neurology

  • Neurology Physician
  • Kernersville, NC
  • NPI 1275911612
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Elizabeth OB/GYN

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Moses Cone Physician Services, Inc.

  dba Alamance Surgical Associates

  • Surgery Physician
  • Burlington, NC
  • NPI 1164980546
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1942479571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "336-277-6430",
            "fax_number": "336-277-6448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 BROAD ST",
            "address_2": "SUITE A",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272842796",
            "telephone_number": "336-277-6430",
            "fax_number": "336-277-6448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICKERHOFF",
        "first_name": "STEPHANIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-28",
        "last_updated": "2020-10-28",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "201811",
            "primary": true
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "NC",
            "license": "201811",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7003723",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stickerhoff4599@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "280 Broad St",
            "address_2": "Suite A",
            "city": "Kernersville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272842796",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kelly Stephenson Thompson, PHYSICAL THERAPIST
• Mary Rebecca W Thompson
• Michael Gray Thompson, RPH.
• Thrive Mama LLC
• Thrive Therapeutic Solutions, PLLC
• Karen M Timbrook-Dillow, PA-C
• Time Well Spent Home Care
• Sydney L Tokotch, LCSW
• Crystal Tomlin, COTA/L
• Desnicia Toney

• Nurse Practitioner in Kernersville, NC
• Providers in Kernersville, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.